Maite Pérez Reyes: the psychology of obesity

Obesity is a reality that affects millions of people, especially in Western culture countries.

But beyond the aspects of this health problem that have to do with physical complications, we must not forget that there is a psychological facet of this form of overweight. To know her better, we spoke with Maite Pérez Reyes, Health Psychologist based in Las Palmas de Gran Canaria and with extensive experience treating cases of overweight and Eating Disorders.

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Interview with Maite Pérez Reyes: the psychological implications of obesity

Maite Pérez Reyes, an expert in Health Psychology, she talks about obesity and its relationship with psychological aspects.

Is obesity a disease of this century?

It is not an exclusive disease of this century but it can become the disease of S. XXI due to the prevalence of it. The change of habits, the sedentary lifestyle, the increase in the availability of food, especially derived from sugar and other factors, make this disease more likely to develop and from older ages early.

What is the relationship between emotions and obesity?

As in any disease, emotions play a fundamental role and in the case of obesity, there are some that are predisposing to suffer it and others that are generated as a result of having problems with the weight.

So much so that the Spanish Community Nutrition Society includes the concept of "emotional balance" within the pyramid of healthy eating.

How can emotions predispose or influence to develop obesity?

There is increasing scientific evidence of the relationship between obesity and certain basic emotions with unpleasant affective experiences, such as sadness, fear, anger... But we identify the problem when these emotions generate self-abandonment behaviors, regardless of healthy eating, physical exercise ...

So, are there certain emotions such as sadness that induce you to eat more or differently?

That's how it is. There are emotions that produce physiological consequences in the body and to counteract them, they seek many times the pleasant effects of certain foods and an addiction to they.

Addiction to some foods?

Indeed. It is what is considered disorder "food addiction"And that includes selecting foods called" comfort "that provide a sense of reward and relief from discomfort.

And how can you act on this?

When the patient already suffers from addiction, work should be done in consultation with specific techniques, such as quitting some foods associated with moods, among others. But the important thing is to act to prevent these addictions.

That is why it is essential not to use food as positive reinforcement and especially in childhood, which is where eating patterns are acquired. In our culture, celebrations always revolve around food and discomfort is alleviated by offering a chocolate or similar.

Why in the face of these emotional states do people not choose to eat healthy foods, but rather those that are more harmful?

This occurs because there are a number of foods, such as refined sugars and carbohydrates that generate pleasant effects because they produce more serotonin, dopamine, opioids and endorphins in the brain, with the consequent relief of negative emotional states.

And what happens if this addiction to food is not intervened?

This addiction to food can also lead to eating disorders, such as Bulimia, Anorexia, Binge Eating Disorder, because sometimes the guilt after eating leads to purgative behaviors and self harmful.

What psychological consequences can suffer from this disease?

Obesity is one of the most stigmatized diseases that exist today, where the patient is blamed, which generates social rejection. This can affect personal relationships, with consequent isolation, depression and of course low self-esteem.

What does the work carried out from the psychology area of ​​an Obesity Unit consist of?

The detection, diagnosis and treatment of those psychological variables related to obesity are carried out. For this, the relationship of patients with their own body, the distortion of his image, his behavior with food, his self-esteem, his personal relationships, and his lifetime.

On the other hand, it is essential to rule out the existence of possible disorders and understand the function that Obesity can present in each patient, either a consequence of personal situations or a cause of other The work of the psychologist is carried out jointly with endocrinology and nutrition, addressing aspects such as motivation, interoception and psychoeducation among others.

How do you intervene on a psychological level with an obese patient?

In the first place, a good rapport with the patient must be created, emotional discharge is encouraged, work is done on establishing an alliance and adherence to the program that will be established for him. What is intended is that you become aware that you are somewhat "deaf to yourself" and that it is necessary to start listening to your body.

And how do you work to increase that self-awareness?

The objective is to reconnect the patient with his organism, first from the most basic, which are the perceptions of the environment, to gradually work on interoception. This will allow the patient to better recognize and differentiate whether he is hungry or "craving to eat" and better regulate food intake.

There are many general guides and recommendations such as chewing slowly, not eating while watching TV, etc. Do these psychological "tricks" work?

There are recommendations that are used and that work in generality, such as nutrition education, self-registration, the establishment of small steps based on the Kaizen philosophy... but the ideal is to use a very personalized. First, the tastes and eating habits of the patients are always taken into account, but above all their previous ideas towards food, diets, the body ...

As one works at the cognitive and belief level, a personalized action plan is elaborated, since, by way of example, “leaving food on the plate” is not the same for one person as for another.

When establishing the plan, individual differences should also be considered, taking into account factors such as, place where meals are made, work hours, possibility of making your own food shopping, etc.

Since affective variables are also addressed, stress management work and unpleasant emotional states generated by behaviors towards food are emphasized.

In addition to this, a system of "custom challenges" is always designed, which include things like abandon definitely a harmful food, introduce or increase a physical activity, abandon habits such as eating the nails etc

So in the obesity psychologist's job, weight is not the only goal. What is truly interesting about these challenges is that they are part of a personal project that is in progress with the patient from the moment they arrive to the consultation and that includes changes in almost all spheres. This generates, on the one hand, discarding the idea that the only objective is weight reduction and, on the other hand, it generates more motivating elements for change.

And if the diet doesn't work... So do you have to resort to surgery?

Bariatric surgery or surgery for obesity is one more of the resources used to face this disease, without However, it is not without risks and the need to have a permanent accompaniment of psychologists, nutritionists and endocrinologists.

In bariatric surgery, what aspects are worked on from the psychology consultation?

From the psychology consultation, both the preoperative and the postoperative are worked.

The candidate for bariatric surgery requires a careful psychological evaluation but, as it is intended that obese patients lose weight and do not regain recover it and that psychological problems are not accentuated prior to surgery, it is essential to carry out, in addition to the assessment, a preparation and follow-up of the patient.

It is necessary to assess eating habits and if there are eating disorders, the patient's ability to understand what it consists of. surgery, the risks involved and the lifelong care it will require and rule out the existence of mental disorders and pathological features of personality.

In the postoperative period, you have to work on fears and ideas and establish a new relationship with food.